Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Nutrients. 2023 Feb 10;15(4):891. doi: 10.3390/nu15040891.
With the increasing incidence of non-alcoholic fatty liver disease (NAFLD) and the aging of the population, sarcopenia is attracting attention as one of the pathological conditions involved in the development and progression of NAFLD. In NAFLD, sarcopenia is closely associated with insulin resistance and results from the atrophy of skeletal muscle, an insulin target organ. In addition, inflammatory cytokines that promote skeletal muscle protein breakdown, low adiponectin levels leading to decreased insulin sensitivity, and hyperleptinemia are also involved in NAFLD pathogenesis. The presence of sarcopenia is a prognostic factor and increases the risk of mortality in patients with cirrhosis and post-treatment liver cancer. Sarcopenia, the presence of which mainly occurs due to decreased muscle mass, combined with increased visceral fat, can lead to sarcopenia-associated obesity, which increases the risk of NASH, liver fibrosis, and cardiovascular disease. In order to treat sarcopenia, it is necessary to properly evaluate sarcopenia status. Patients with high BMI, as in sarcopenic obesity, may improve with caloric restriction. However, inadequate oral intake may lead to further loss of muscle mass. Aerobic and resistance exercise should also be used appropriately.
随着非酒精性脂肪性肝病（NAFLD）发病率的增加和人口老龄化，肌少症作为 NAFLD 发生和发展过程中涉及的病理状态之一引起了人们的关注。在 NAFLD 中，肌少症与胰岛素抵抗密切相关，是胰岛素靶器官骨骼肌萎缩的结果。此外，促进骨骼肌蛋白分解的炎性细胞因子、导致胰岛素敏感性降低的低脂联素水平以及高瘦素血症也参与了 NAFLD 的发病机制。肌少症的存在是一个预后因素，并增加了肝硬化和肝癌治疗后患者的死亡风险。肌少症的存在主要是由于肌肉量减少，加上内脏脂肪增加，可导致与肌少症相关的肥胖，从而增加 NASH、肝纤维化和心血管疾病的风险。为了治疗肌少症，有必要正确评估肌少症的状况。高 BMI 的患者，如肌少性肥胖，可能通过热量限制得到改善。然而，摄入不足可能导致肌肉量进一步减少。还应适当使用有氧运动和抗阻运动。
